Neighborhood News
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Announcements
- Neighborhood’s Reponses to the Supply Shortage of Generic Children/Infant Tylenol and Motrin
- Provider Manual Annual Update
- New eForm for Requesting PCP Changes
- Updated Quick Reference Guide
Reminders
- Ensure the Service you are Requesting Requires Prior Authorization
- Medicaid Eligibility Redetermination
- Provider Screening Requirement with Rhode Island Medicaid
Payment Policies
Quality Improvement
Medical Management
- Neighborhood’s Peer-to-Peer Review Process and Phone Line
- Process Improvement for Long Term Supports and Services (LTSS) Waiver Applications
Behavioral Health
- Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
- Free Pyx Health App Helps with Feelings of Loneliness and Depression
- Behavioral Health News and Resources
Claims
- Claims Corner
- Claim Adjustment Requests: Delay in processing and eForm guidance
- Claim Forms: Guidance and revised Claim Form Finder
- Coordination of Benefits
- Claim Submission Reminders
Pharmacy
Monthly Pharmacy Benefit Changes: On a monthly basis, Neighborhood places a list of formulary changes on its website for each line of business. For more information, please visit the Pharmacy Provider Resources webpage at: https://www.nhpri.org/providers/provider-resources/Pharmacy/
- Medicaid and Commercial Limited Specialty Pharmacy Network
- Cure’s Act – Screening of Medicaid Providers
- Pharmacy Benefit Medicaid Drug Rebate Program (MDRP)
- How to Bill 340B Correctly
- Electronic Prior Authorization (ePA) for the Pharmacy Benefit
- Medical Benefit Prior Authorization Submissions
- Searchable Formulary for Pharmacy Benefit and Medical Pharmacy Medications
- Opioid Prescribing and Alternative Therapies for Neighborhood INTEGRITY (MMP) Members
- Prescription Drug Coverage in Assisted Living and Long-term Care Facilities
- Requests for Out of Network Pharmacy Services
- No-Cost, At-Home COVID-19 Test Kits
Specialty Medication Prior Authorization Criteria Update: As of February 1, 2021, Prior Authorization Requests for Specialty Medications require submission of the member’s chart or medical record documenting medical necessity based on the criteria corresponding to the indication. The specialty drug prior authorization request will also require submission by the provider’s office and not by a third party.